Reacting to a Bloomberg News article criticizing a Salinas urology clinic, a national organization has condemned the actions of doctors who "self-refer" patients, saying they are "motivated by profit."

The Nov. 6 Bloomberg report by Peter Waldman implied Salinas Valley Urology Associates and its participating doctors are recommending an expensive but often unnecessary or ineffective type of radiation therapy for prostate cancer patients in order to increase profits.

The business at 1115 Los Palos Drive, owned by doctors Steven Worsham and Aytac Apaydin, allegedly "self-referred" patients to use intensity-modulated radiation therapy, or IMRT, according to the report.

Self-referral is an industry phrase describing the practice of doctors referring patients for treatments in which they have a financial interest through ownership or investment. When it comes to IMRT, there is ample motivation for the practice.

According to the Bloomberg report, Medicare pays doctors up to $40,000 per patient for IMRT, 20 times as much as they would be reimbursed for performing surgery on the same patient. Proponents of IMRT, which focuses multi-angled X-rays on tumors, say it delivers bigger doses with fewer side effects than surgery or radiation.

The American Society for Radiation Oncology, the nation's largest radiation oncology organization, said that doctors who refer patients based on how much they will be paid for procedures hurt those they are supposed to help and waste resources.

"The time for debate and analysis of self-referral is over," society president Michael L. Steinberg said in a statement issued the day of Bloomberg's report.

The society cited a September article in the New England Journal of Medicine that called for the end of self-referral loopholes and an October report from the federal Government Accountability Office that found providers made more referrals for advanced imaging services than if they were not self-referring.

Salinas Valley Urology Associates said in a statement Thursday that the Bloomberg News report had "the facts wrong."

In November 2011, the state Department of Public Health cited the company for having two unregistered X-ray machines, spokeswoman Anita Gore said in an interview.

The department regularly monitors facilities with X-ray machines through its radiologic health branch, she said. It was unclear if the machines cited were the same that used IMRT, Gore said.

The company was not fined for the machines because they submitted the required documents for them after the inspection, she said.

A local man's story

News of Bloomberg's investigation of Salinas Valley Urology and its doctors quickly reverberated through the Monterey County medical community. It has begun to spread to the larger population, leaving some patients devastated by the possibility they were unnecessarily treated.

One Monterey County registered nurse said her 77-year-old father was referred to the clinic for IMRT by Dr. Apaydin. The treatment was stopped after 38 sessions because the side effects were debilitating, she said.

At the time, she thought it odd that her father declared his cancer was gone, but was not required to get a follow-up biopsy or checkup. But her father is a proud Latino man, she said, who would not discuss such delicate medical issues with her.

"My heart just sank when I read that article," she said.

She shared it with her mother and father, who is so depressed and mortified, she said, he did not want to be identified. She spoke on the condition her name not be used.

The nurse said she immediately demanded her father's medical records. They were more disturbing than she expected.

She said the records showed Apaydin had conducted three prostate biopsies on her father since 2004. Accustomed to reading medical records, she said they showed no cause for the first two biopsies. The third was prompted by a rise in his prostate-specific antigen, or PSA, level from 0.21 to 0.4.

The woman, a registered nurse for three decades, said a PSA below 4.0 is considered normal.

The third biopsy took 17 core samples. Records indicate two showed low levels of cancer, for which many urologists would recommend no immediate action.

Apaydin, she said, told her father his only choices were IMRT or surgery and, because of his complicated medical history, surgery wasn't an option. The man told his daughter a radiation oncologist at Salinas Valley Urology discouraged him from seeking a second opinion.

"In my culture, particularly with older people, they do not question a physician," she said. "They are like next to God. A doctor's word is as good as gold."

She said she believes her father was the victim of elder abuse and plans to report his case to state and local medical authorities at the least.

"I can't believe they could have honestly put their head down every night and gone to sleep with no guilty conscience," she said.

The ultimate insult, she added, was when the office gave her father a certificate, with Mickey Mouse doffing his graduation cap, congratulating him for making it through the "torture" of his treatments.

As referenced in the Bloomberg article, her parents witnessed patients being chauffeured in limousines to the clinic. At times, they told her, there was a line out the door they were so busy.

'Sitting on a gold mine'

The use of IMRT has surged in the past few years at urology radiation centers across the country, according to the Bloomberg report.

Citing local doctors, the report said Apaydin told radiation oncologists they were "sitting on a gold mine" and urged them to refer patients to him for IMRT procedures so they could be "sharing in it."

Apaydin and fellow owner Stephen Worsham declined to comment on specific criticisms of their business. A Herald reporter was told at the urology office Friday there would be no comments outside of Thursday's news release.